| Research background and purpose:Climate change is one of the greatest public health challenges facing humanity.To understand the trends of average temperature and air pollutant concentrations in the Sichuan basin in recent years,and to analyze the association between extreme temperatures and population non-accidental deaths,respiratory disease,cardiovascular disease and cerebrovascular disease deaths,as well as temperature-related mortality burden in the Sichuan basin using a distribution lagged nonlinear model(DLNM).It provides valuable information for the development of health interventions and related public health policies in the Sichuan basin.Data Source and Method:Daily mortality data,meteorological data,and air pollutant data for four cities with different climate types in the northern,central,and southern in the Sichuan basin from2016-2021 were selected for this study.We used a distributed lag nonlinear model(DLNM)to quantify the association between temperature and non-accidental mortality,respiratory disease,cardiovascular disease,and cerebrovascular disease deaths in each city,the model controls for confounding factors such as pollutants,relative humidity,long-term trends,and day-of-week effects.Multivariate meta-analysis was performed to obtain the overall cumulative risk.The attributable fractions(AFs)were calculated to access the mortality burden attributable to both extreme and moderate temperatures.Additionally,we performed a stratified analyses by gender,age group,education level,and marital status.Results:1.For the period January 1,2016-December 31,2021,a total of 751,930non-accidental deaths were recorded,including 258,045 cardiovascular,171,201 respiratory,and 133,599 stroke deaths,respectively.The exposure-response relationship between temperature and total non-accidental mortality showed an inverted "J" or "U" shaped curve,with a minimum mortality temperature(MMT)of 25.1°C,the 79.5th percentile of the mean daily temperature.The MMP and MMT for cardiovascular disease,respiratory disease,and stroke were 68.0%(22.7°C),79.5%(25.6°C),and 71.5%(23.8°C),respectively.2.The results of the study found that extreme temperatures increased the risk of non-accidental death,cardiovascular disease,respiratory disease and stroke death.The lagged effect of extreme cold was not significant on the day of the lag and in the first 2days,and began to appear on day 3,peaking at day 4 and lasting until day 25;the lagged effect of extreme heat was greatest on the day of the lag,after which the thermal effect gradually decreased and lasted only about 5 days.The cumulative relative risk(CRR)of extreme heat for non-accidental death,cardiovascular disease,respiratory disease,and stroke death were 1.38(95% CI: 1.21,1.58),1.32(95% CI: 0.96,1.83),1.75(95% CI: 1.26,2.41),and 1.42(95% CI: 1.10,1.84),respectively.The cumulative relative risk of extreme cold for non-accidental death,cardiovascular disease,respiratory disease,and stroke death were 2.12(95% CI: 1.52,2.97),3.55(95% CI:2.04,6.19),2.17(95% CI: 1.44,3.26),and 2.76(95% CI: 1.84,4.14),respectively.3.Stratified analysis by age,sex,education and marital status found that the risk of death was greater among those aged 65 years and older,women,those with low education,and those who were divorced,widowed and unmarried,with CRR of 2.26(95% CI:1.63,3.13),2.19(95% CI:1.52,3.16),2.40(95% CI: 1.56,3.71)and 2.62(95%CI: 1.54,4.43),respectively;CRRs for extreme heat were 1.49(95% CI: 1.31,1.71),1.69(95% CI: 1.43,2.00),1.34(95% CI: 1.12,1.60)and 1.58(95% CI: 1.02,2.46).4.The burden of death from non-accidental deaths,cardiovascular disease,respiratory disease,and stroke caused by non-appropriate temperatures was further assessed.The results found that 10.16% of non-accidental deaths,14.0% of cardiovascular disease deaths,9.68% of respiratory deaths,and 13.91% of stroke deaths were attributed to cold and heat.The majority of temperature-related deaths were caused by cold,with 9.10%(95% e CI : 5.18%-12.27%)of non-accidental deaths,12.34%(95% e CI : 7.01%-17.09%)of cardiovascular disease deaths,8.30%(95% e CI : 1.90%-14.19%)of respiratory disease deaths,and 12.23%(95% e CI : 6.26%-17.10%)of stroke deaths.And a small proportion was attributed to heat,with 1.06%(95% e CI :0.74-1.31)of non-accidental deaths,1.96%(95% e CI : 1.15%-2.60%)of cardiovascular disease deaths,1.39%(95% e CI : 0.71%-1.95%)of respiratory disease deaths,and 1.68%(95% e CI : 1.09%-2.23%)of stroke deaths.5.In terms of different cities,the burden of death attributed to non-appropriate temperatures was higher in Guangyuan in the north for respiratory and cardiovascular diseases,and in Panzhihua in the south for stroke.Stratified analysis by sex,age,education,and marital status showed that those aged 65 years and older,females,low education,and divorced,widowed,and unmarried were more sensitive to extreme temperatures.In contrast,the burden of death due to non-appropriate temperatures was greater among those aged 0-64 years,females,low education,and divorced,widowed,and unmarried,with an overall AF of 12.42%(95%e CI:-1.85%-21.90%),12.37%(95%e CI: 6.71%-17.43%),10.54%(95%e CI: 6.56%-11.11%)and 14.74%(95%e CI:9.56%-18.97%),respectively.Conclusions:Extreme temperatures increase the risk of non-accidental death,cardiovascular disease,and death from respiratory disease in the population,with the greatest burden of cold and heat death from cardiovascular disease.The burden of mortality from extreme low temperatures is much higher than that from extreme high temperatures,with most of the temperature-related mortality burden attributed to moderate low temperatures.The MMT varies across diseases and regions,with those aged 65 years and older,females,with low education,divorced,widowed,and unmarried being more vulnerable to extreme temperature,and those aged 0-64 years,females,with low education,and divorced,widowed,and unmarried having a greater burden of death due to non-appropriate temperatures.Therefore,in the context of global climate change,timely and effective health adaptation actions for vulnerable populations are recommended,and relevant adaptation plans should be developed to reduce the adverse effects of climate change on human health. |
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